Great Games You Never Played: Pathologic

"Fine, obscure gems." Part of a periodical series: Great Games You Never Played. 

Pathologic may be the most unique and remarkable game I've ever played. Developed by the Russian studio Ice-Pick Lodge in 2005, Pathologic plays kind of like a cross between Silent Hill and Morrowind. It takes elements from different genres (FPS, RPG, adventure, survival-horror) and blends them all into a uniquely weird, disturbing, glorious, compelling, brilliant, horrifying, surreal experience. Whereas most games strive to create bustling, life-like cities and locations, Pathologic instead offers a dying city.

You play as one of three possible main characters arriving in town just before a deadly plague breaks out. As the town falls into a quarantine state and the plague kills more and more people every day, your mission is to find a cure to the disease and escape with your life. You have 12 days to accomplish this, with each day bringing about new tasks and challenges that threaten your survival.

It's a wonderfully original premise that's also fleshed out with intelligent gameplay mechanics. The face of the city constantly changes as the plague sweeps through different districts and as people fall further into decay and madness. Your survival hangs on your ability to manipulate a brutally harsh economy while micromanaging limited resources. Staving off infection is not your only concern, however, as death can come just as easily at the hand of a madmen or from simple starvation.

The atmosphere this creates is simply phenomenal, with you really feeling (and seeing) the effects of the plague as you try to get by in this hellish scenario. I've never felt more vulnerable in even the most renowned of survival-horror games, and even the story offers a lot of intrigue and philosophical depth, if you can understand all that happens in this weird, twisted place. Pathologic is just such a monumental game, and it's a shame more people don't know about it. If you're in any way intrigued, continue reading to learn more.

Before I go any further, I feel I should mention Quintin Smith's write-up of Pathologic over at Rock, Paper, Shotgun. It's a three-part series wherein he explains why "Pathologic is the single best and most important game that you’ve never played." It's a pretty remarkable analysis that convinced me (and countless others) to buy the game. The man deserves a lot of credit (perhaps even a commission) for a lot of the game's sales over the last four years.

I hesitate to recommend reading all three of Quintin's articles, however, because they become progressively rife with spoilers, as well as things that border on outright embellishments from someone who's perhaps just a little too passionate about the game. Part 1 is a solid read, but parts 2 and 3 can be a little "out there" at times. Even still, they offer a lot of insight into the deeper nature of the game and are rather fascinating. Check them out sometime.

Right then, continuing on.

Like every reviewer before me who's ever attempted to describe Pathologic, I find myself struggling to do the game justice through mere words. Pathologic defies a number of video game conventions, which makes it difficult to describe in terms of the conventions with which we're all familiar. Trying to compare it to other games or defining it by some kind of genre is just a crude bastardization that doesn't nearly capture the essence of what Pathologic is. It's just something you have to experience for yourself, and that's how you know it's something truly special.

When you start a new game, you find yourself in a theater with three people talking on a stage, and with you in full control of your perspective. The three speakers are the playable characters, discussing the disease and whose methodology is best for solving it. It's a preamble that literally sets the stage for the rest of the game, establishing the characters, the central premise, and perhaps most importantly, the running theme of each playable character being an actor on a stage. When their conversation is over, they agree to go their separate ways, walk off stage, and freeze in place as the lights dim, with you still in control of your perspective as you head towards the exit.

It's only then that the character selection screen pops up, presenting your three character options: Daniel Dankovsky (aka "The Bachelor"), a traditional med school doctor; Artemiy Burakh (aka "The Haruspicus"), a kind of folk shaman; and Klara (aka "The Devotress"), a sort of semi-divine mystic. Each is a healer of sorts brought to the town for their own reasons, before becoming caught up in the plague. Whomever you choose, the other two will be present in your game going about their own business and even interacting with you as necessary. Each character plays radically different from the next and has their own unique story and quests, making it feel like there are three different full-length games all happening in the same setting.

With three distinct playable characters, a single playthrough only grants you a single angle on the overall story. Each character focuses on different aspects of the plague (and of the town itself), befriending different critical NPCs, which leads to all kinds of unique insights when playing as different characters. You hear about something as one character, and it remains an intriguing, unexplained mystery, but then playing as another character, it becomes clear. Practically speaking, you wouldn't really want to play the game three times to get the whole story, but it adds a lot more depth to the experience when you know that everything isn't always as it seems, and that there's more to the story that you aren't being told.

The narrative deals primarily with uncovering facts about the town's sordid history and all of its weird idiosyncrasies. From the moment you first arrive, it's pretty clear that this is a bizarre and other-worldly place. The architecture of all the buildings has a gothic flair to it, with many of the designs looking downright creepy at times. Everything is a washed-out shade of brown and gray earthtones, seemingly devoid of life. You've got all kinds of drunks shambling around the streets with demented smiles on their faces, and children running around claiming no parents. When people start dying, suspicions immediately arise that it's the work of a demon, shebnak-adyr, "the clay cannibaless," and everyone goes on a witch hunt.

As you talk to people, you learn that the town was basically founded on the meat industry. The eastern side of the town houses the massive Abattoir, the slaughterhouse where all of the meat is produced. You don't know what goes on in there, other than rumors, and common townsfolk are generally scared of the beast-like butchers and treat them almost like outcasts. Two rivers run through the city, but everyone says not to trust the water because it's contaminated from all the blood of the slaughtered cows. At the start of the game, when news of the infection hits, the Abattoir gets locked up and meat production comes to halt with all of the workers still inside, the giant, bloody sacks of meat left out to dry and rot on the pulley system leading out from the town.

Extending off from the Abattoir is the Apiary, a tall, mammoth structure with barred, irregularly-placed windows. The Apiary is basically where the outcasts and mad men get sent to live. Like the other notable structures, it too has been closed off from the public by the time you arrive. All you know of it is that the butchers, the Odonghe (strange-looking humanoid creatures, colloquially referred to as "worms"), and the bull worshipers live there, and they've been trapped inside since the outbreak. Dead bodies get sent through the Apiary, but you have no idea as to why.

Other places, like the Polyhedron, defy physics or logical explanation. It's a massive structure that stands on basically nothing; it really should fall and crumble under its own weight, but it stays upright for some unknown reason. People tell you it was built with very particular physics from the mind of a genius architect (responsible for other impossible architecture, like the "stairways to heaven" that decorate the town). And yet, further investigation seems to suggest more mystical properties that even the creator can't explain clearly. Perhaps even more bizarre is how all of the town's children have taken residence there, forming an exclusive society within the impossible walls of the Polyhedron.

Each character explores one of these places in-depth and becomes familiar with how it relates to the town and to the plague, while learning about the other two in rudimentary description from the other playable characters. This creates quite a lot of intrigue as the game presents you with such monumental structures and then restricts your access to them. Being told that you can't go in only makes you more curious about them, while they serve as critical mysteries in the developing plot.

Some of the first characters you meet serve as the tutorial, explaining how the game mechanics work. But they're not talking to your character, they're talking to you -- the player. They specifically reference that "Our dialogue is very important! It is connected with the rules of the game!" and your character responds with baffled confusion "What game, Man in a Mask? I am no actor!" They explain this to you because "it is a tradition to tell the actor what to do, when he comes out onto the stage, otherwise he'll fall off of it." Just like with the theater introduction, this tutorial clues you in from the very beginning that this is going to an oddly surreal experience.

Each day in Pathologic usually begins with you receiving a letter from a notable NPC who requests your assistance with some issue, or has some information that might prove useful in your mission to stop the plague. These are your daily "main quests" that you have to complete to progress to the next day. Each day also brings several optional side quests that offer more insight into the town and its residents while (usually) giving you opportunities for extra rewards. You don't have to complete them, but if you haven't finished them by the end of the day, then they remain unresolved for the rest of the game, being replaced the next day with a new batch of quests.

And so, every day brings with it a time limit to complete the daily missions while doing all of the tasks necessary to keep yourself alive. If you find yourself close to death, then you might have to spend an entire afternoon digging through trashcans, looking for junk to trade for some medicine, or scrounging up enough money to buy it from a shop, which then gives you less time to finish the daily missions. How you manage your time becomes one of the most important aspects of the game.

Your survival in Pathologic depends on several statistical meters. You have to eat, and so a meter fills up the longer you go without food. You have to sleep, and so a meters fills up the longer you go without sleep. You have to watch your health, which takes damage from ordinary combat and depletes over time while you're infected. You have to keep your immunity to the disease up by taking medicines, and when you're infected, you have to treat your infection level with various types of antibiotics. On top of all of this, you have to maintain your reputation with the town, which is affected by your actions.

The brilliant thing about this survival system is that literally everything you do in the game has some kind of consequence to those meters. These meters constantly lurk in the background, always changing no matter what you're doing. You can't escape them. The other great thing is that doing something to alleviate one meter almost always has a negative effect on another meter. Many of the healing items raise your exhaustion, and are thus best taken at the end of the day. Most of the medicine you can take to treat your infection or to boost your immune system also damage your health. Going to sleep reduces your exhaustion, but raises your hunger.

So to stay alive, you have to acquire all sorts of things to maintain your meters. Different foods, all kinds of different medicines, weapons to defend yourself, clothes to protect against the disease or to defend against attacks, and money to buy and repair these goods (they deteriorate over time or with use). None of this is particularly easy to acquire, since the economy in a quarantined town gets thrown to hell. On day 2, the price of food increases by 1000%. You can trade numerous things with local townsfolk, but the longer the plague goes on, the fewer citizens are left alive to trade with. And all of the best equipment costs so much money that you have sell a few kidneys for it (figuratively, of course, unless you're the Haruspicus).

The economy in Pathologic is really quite sophisticated for a video game, and proves to be one of the game's best aspects. As important as money may be for buying items from stores and for completing quests, a lot of your valuable resources come from garbage bins. Empty bottles, sewing needles, discarded razors, broken watches -- junk. But then you realize that you can fill empty bottles with water and then trade them to wandering drunks for bandages, and you can trade the needles to young girls for bullets, and you can trade the razors to young boys for medicine.

Figuring out how to manipulate the economy is a real challenge at the start, and then it becomes a rewarding and integral component to your survival. The cost of goods changes from day to day, coinciding with the major events of the town, which then creates a dilemma of "Do I buy this medicine now, even though it might be cheaper tomorrow? The price might go up, so it might be better to buy it today. But then again, do I really need the medicine? My infection is still pretty low, so maybe I can get by for two days without any. But if I do that, then maybe I'll need to buy some extra morphine to take before bed."

An early source of income is to fight the thieves and murderers that come out at night. You get positive reputation for killing them, and they each carry a few hundred monies around, along with razors that you can trade, and sometimes extra weapons. But doing so wears out your weapons (and clothing, if you get hit) even faster, which you'll just have to spend more money repairing, and will leave you more exhausted during the day, thus leaving you less time to finish your daily tasks. So no matter what you do, there's always some kind of trade-off, adding significant depth to every moment of the experience. Taking time out to better your personal situation puts the fate of the town at risk, but what good are you to the town if you die from starvation?

Making it to the end of a day is a genuine accomplishment in this game, considering all the work you have to do to stay alive, and that the game really doesn't care if you live or die. It won't hold your hand to make sure you get through to the end; it's entirely possible to make it through 10 days and then back yourself into a corner where you have absolutely no hope of survival, short of loading a save from a few (in-game) days ago. Or perhaps to save yourself the agony of replaying several hours of the game, you end up in terrifying, desperate scenarios where you have to sell your only weapon for a few scraps of bread, or murder a child for the medicine he's carrying while you're about to die from infection. That's true horror right there.

Each day, different districts of the town become infected. You can buy a map each day that marks the infected districts, but you can always tell you're about to enter one from the familiar, foreboding scarecrows setup around the border. Once you enter, the screen turns to a thick shade of green. Clouds of pestilence billow around you and blow through the streets. The houses become plastered with blood and filth. Rats scurry about, biting at your ankles, and droning plague-bearers try to latch on to you as you pass. The sick lie on the ground moaning in pain. And the guards attack any infected that try to leave.

It's a horrifying sight the first time you enter an infected district, and they just get worse over time. They're easily avoidable early on, except when a mission sends you directly into one, but towards the end of the game the disease is so pervasive that everywhere you go will have felt the effects of the plague. And the music that plays in these districts is equally creepy and haunting. (Most of the music is, in fact, extremely atmospheric, and adds a significant amount of character to this uniquely bizarre experience.)

Music that plays inside infected districts, with a screenshot slideshow

It's inevitable that you'll eventually contract the disease, no matter how diligent you are about avoiding it, and when you do, you'll find yourself in a far more pressing dilemma than any other disease you ever contracted from other video games.

Once you have the disease, your infection meter progressively fills up over time, occasionally blurring your vision and causing damage to your health. The higher your infection level, the quicker it kills you. At first, you can't completely cure it; your only way of dealing with the infection is to treat it with antibiotics. Some kill active bacteria in your system (lowering your infection level), while others slow the growth rate of new bacteria (how fast your infection level increases over time). Every antibiotic deals a certain amount of damage to your health, so if your infection is nearing max and threatening to kill you, taking the medicine might kill you just as quickly if you're all out of healing items and low on health.

When you're infected, you have to ration all of your supplies. Taking medicines early can prevent you from winding up in a bad situation later, but it's sometimes a gamble whether you can get more medicine later on, so maybe you might be better off hoarding a small amount of back-up reserves for emergencies. Or maybe hoarding them isn't such a good idea, since your condition will only get worse and it'll be harder to treat later on. Every night I felt relief and gratification at having survived to the end of another day. But then the dread always hit me as I looked at my available supplies and tried to budget how I should prepare for the next day.

Besides the main goal of finding a way to stop the plague, each character has an additional goal of keeping 10 critical NPCs (described as "adherents") alive to the end. These characters can also become infected, and you'll have to use your own supplies on them. As you progress through the 12 days, you eventually discover ways to cure individuals of the plague, but these curative items become a limited resource, and you have to wonder if you should use them on yourself (even though you might contract the disease again later), or save them for your adherents. So you not only have to micromanage resources to keep yourself alive, but you also have to make sure you have enough supplies to heal anyone else who might become sick.

The story continues with each character learning more about the plague and about the town, until the final conclusion on the twelfth day when the player has to decide what to do to "save" the town (provided you've kept all of your adherents alive). The final decision is a little forced, but you become so familiar with the town and its denizens that you can't help but feel some kind of moral attachment to one decision over another. I don't want to spoil anything, but let it be said that the final resolution makes all of the preceding stress and misery worth it, while the "secret ending" that you can get from saving two sets of adherents can be completely mind-blowing, while adding a lot of extra philosophical depth to the experience.

Perhaps even more fascinating than the plot development is how the town physically changes over the course of 12 days. When you first arrive, the town is typical, but on day 2, things start to change. Infected districts start cropping up around the city with pestilence sweeping through the streets and the infected moaning in pain. After the disease has run its course through these districts, they get closed down and become practically barren, with only violent looters braving the now-empty houses.

After a few days, a group of anarchists take to arms, lighting the city on fire by throwing molotovs at everything that moves. Murderers and thieves start to populate the city streets even during the day, and eventually there's just so much rampant chaos that you're utterly helpless to put a stop to it. You can kill every criminal and madman you come across, but it gets to a point where you're just wasting valuable time and resources, and you might be better off to tuck your head and just allow the chaos to run its course.

An inquisitor is eventually sent to resolve the issue through diplomatic means, trying to get the three ruling families to come to an agreement. When that doesn't prove entirely successful, the military arrives to crack down on the chaos and solve the dilemma through brute force. Suddenly you've got armed guards patrolling the streets and shooting every criminal and plague-bearer that crosses their path. As the plague rages on and the death toll rises every morning, fewer and fewer people are left wandering the streets for you to trade with, all-the-while the prices in the economy fluctuate along with the daily changes.

It's simply amazing to watch the city change over the course of the game. You can really feel the effects of the plague, with people becoming more and more desperate and hopeless, while the dregs of society come out to thrive on the misery of others. The atmosphere is so thick that you almost choke on it, and I don't think I've ever seen such a dynamic setting in any video game before. Even while this town is slowly suffocating and dying, it feels more alive than any other town I've visited in any other game.

That's not to say that Pathologic is a perfect game. Far from it. Practically speaking, Pathologic is actually a pretty bad video game. As brilliant as it is, it's riddled with problems that hold the game back and leave it noticeably flawed. For the most part, the game's strengths are so monumental that the flaws can almost be overlooked entirely, but if you're just starting out and have no idea what to expect, they can almost ruin the experience.

The main culprit is the wonky translation from Russian to English. Characters frequently talk in ways that fluctuate between being cryptically puzzling, comically bizarre, or strangely poetic. More often, it's just a problem of weird grammatical issues making it slightly more of a challenge to figure out what exactly a couple of sentences are getting at. And yet, this weird issue with the translation produces an uncanny effect of making every character seem slightly demented, pushing the game further into the uncanny valley between reality and fantasy, where you're not quite sure if this is real or not.

The other thing you'll immediately notice is the dated graphics and animation quality. Pathologic was released in 2005, but looks (and feels) more like something from 2002. Character models look pretty bad by 2005 standards, and every type of NPC shares the same model as every other character in that category (merchants all look the same, guards all look the same, factory workers all look the same). Most animations look extremely clunky and awkward, textures and polygon counts are awfully low-quality, there's a really limited draw distance. And yet, the low draw distance produces an unsettling fog effect reminiscent of Silent Hill, while the overall artistic style and direction of the game remain fascinating and visually stimulating.

Combat is not very good at all. Pathologic isn't supposed to be a real shooter or action game, so expectations aren't especially high in the first place, but the combat just feels barely functional. With a firearm equipped, the crosshair feels like it moves around on a grid system that makes aiming feel really imprecise, while also demanding microscopic precision with your mouse. Melee combat has a really weird rhythm of clicking to attack with your knife, moving forward so that the one-second delay on the attack connects with the target, and backing up to avoid their attack while you prepare another hit. It feels more like a synchronized dance than a fight.

The interface is fairly counter-intuitive at first, with the trade window being one of the game's biggest challenges to figure out. It doesn't look very sleek or appealing, either, with so much of the dialogue screens covered with black windows and those gray borders, and things aren't always explained very clearly once you're in the game. Sometimes your journal entries or map markers wind up being kind of vague and nondescript, which leaves you feeling directionless at times, not sure what to do. 

On one occasion I was supposed to meet some characters at the "Rail Station" at 10pm. The rail station is a huge place and I didn't know where they specifically meant to meet. I made a hard save and went to the obvious spots, waited for people to show up, saw no one, then started trying to wander all around the premises with no luck finding anyone. After consulting a guide, I found out that I was supposed to be stood up and then confront them about it later. There I was stressing out thinking I'd done something wrong, when a journal entry never popped up to clue me in that they had stood me up.

Perhaps the worst part of the game, though, is your painfully slow movement speed, and the fact that every single quest sends you halfway across town, for whatever reason. You end up spending a majority of your time trudging around, slowly walking from place to place, and it can be pretty boring and tedious sometimes. And yet, this is an absolutely crucial component to the game, because this is where all of the survival aspects happen -- dodging the plague, defending yourself against criminals and madmen, scavenging through dumpsters looking for junk, and trading with random citizens you meet on the streets. 

This is why you wouldn't feel immediately compelled to replay the game as another character. Even though they each have their own radically different quests and unique playstyles, each providing a different angle on the story, a majority of the gameplay remains basically the same -- endlessly walking from place to place and micromanaging all of your statistical meters. This aspect of the game can literally be a chore at times, even though the survival mechanics (and economics) are so sophisticated. 

Pathologic is a diamond in the rough. It has its noticeable problems, but its core concepts are so original that the game is absolutely worth playing, because there's just nothing else that really shows this kind of ambition. It's a monument in terms of design, that just happens to lack the necessary polish to be at its absolute best. Pathologic envisions a dying city, and as flawed as some of its execution may be, the underlying gameplay mechanics still manage to conjure genuine feelings of dread and desperation like no other game has ever achieved. It's a wonderfully surreal experience. Anyone with a bit of patience and a sincere appreciation for innovation should consider playing it. 

If you're interested in giving it a shot, you can buy a digital copy through Amazon, GamersGate, or GameFly (formerly Direct2Drive). If you have a subscription to OnLive, you can also play it there. Alternatively, if you don't want to play the game yourself, you can read some narrative accounts of different people playing each of the characters over at the Pathologistics blog. They're basically a series of daily "Let's Play" features from each character's perspective, in written form so that you don't have to sit through the mind-numbing dullness of watching the game. You might also consider a similar account of a Bachelor playthrough over at The Frip and the Dead.